Transcript Prevention Opportunities and a Systems Approach

FIRST 5 Santa Clara County:
Prevention Opportunities and a Systems Approach
Early Childhood Funders Meeting
Thursday, May 23, 2013
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FIRST 5 Who We Are
Our Vision
To act as a catalyst for ensuring that the developmental
needs of children through age 5 are a priority in all sectors
of the community.
Our Mission
To support the healthy development of children through
age 5 and enrich the lives of their families and
communities.
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Circles of Influence
Ecological Systems Model
adapted from:
Bronfenbrenner, U. (1989)
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FIRST 5 Goal Areas
GOAL 1
GOAL 2
Children are born healthy
and experience optimal
health and development
Health Care
Family
Support
Neighborhood
Support
Early Care and
Education
GOAL 4
Neighborhoods and
community are places
where children are safe,
neighbors are connected
and all cultures are
respected
GOAL 5
Systems are responsive to the needs of children and families
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Families provide safe,
stable, loving and
stimulating homes
GOAL 3
Children enter school fully prepared
to succeed academically,
emotionally, and socially
FIRST 5 County-Wide Service Delivery
Continuum
SCC
Community
Children 0-5 and
their families
Community Engagement and Education Support
Early Care and Education
Children 0-5
Children in system entry
points and at 300% of Federal
Poverty Level
Children and families who are
screened and in need of one-on-one
parenting skills intervention
Children and families that require intensive
intervention services
Workforce Development & Family
Support Strengthening
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Communication,
Education &
Information
Communication, Education, & Information
Assessment
Home Visitation
Therapeutic
Services
Community Outreach,
Learning Together
Initiative, Physical Health
Quality early learning
environments, PoP, Educare
Mental Health Department Call
Center and Regional Assessment
Centers
Community-based HV, Medi-Cal
providers
Community-based therapeutic services,
Medi-Cal providers
Research and Evaluation
Continuous Improvement
Where FIRST 5 Serves – Countywide Risk Factors
Children living in high/
multiple risk environments
are at greater risk of:
- Physical impairment
- Cognitive impairments
- Social, emotional, and
behavioral impairments
- Poor developmental
outcomes
- Serious emotional problems
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Developmental Screening Initiative Evolution
2011 - 2013
2009
2006
2005
2004
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Developmental Screening Target Population
Most vulnerable children birth through 5 in
Santa Clara County
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Superior Court System (Family, Dependency &
Probation)
SCCOE: Head Start
SCCOE: Early Start
San Andreas Regional Center
FIRST 5 Early Learning Programs
Preschool / Early Learning Programs
VMC Pediatric Offices / Community Health
Clinics
Santa Clara County Mental Health Department
Public Health Nursing
WIC
Community Based Organizations
FIRST 5-Funded Community Operated Family
Resource Centers
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Referral Pathway & MHD Call Center
Developmental Screening Target
Population
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KidConnections Network of
Providers
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Santa Clara County STARTS System
Screening to Assessment, Referral, and Treatment
ASQ/ASQ-SE Screenings and Concerns
Mental Health Department
Call Center
Phone: 1-800-704-0900
Fax: 408-938-4536
Referrals
KidConnections Network of Providers
Intervention Services
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(Screening, Assessment, Home Visitation,
Therapeutic Services)
Partnership: FIRST 5 and Mental Health Department (MHD)
Since 2006, FIRST 5 and MHD have partnered to provide
screening and early intervention services to children in
Santa Clara County.
 Shared Vision of Universal Screening and Intervention
 Braided and Leveraged Funding for Sustainability &
Capacity Building
 Programmatic Service Efficiencies
 Implementation of Evidence-Based Practices
 Shared Resources for Workforce Development
 Research-Based Screening and Assessment Tools
 Rigorous Evaluation Plan
 Commitment to Continuous Improvement
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FIRST 5 Leverages $2.54 for every $1 of Investment
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KidConnections Network (KCN) of Providers
• In collaboration with FIRST 5 Santa
Clara County, Santa Clara County
Mental Health Department and
Community Based Organizations KCN provides high quality,
transdisciplinary screening,
assessment, home visitation and
therapeutic services for children
under 6 years of age
• Partnering with the community:
– Pediatric Workgroup
– Provider Workgroup
– FIRST 5, MHD, CBO - Executive
Director Workgroup
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KidConnections Network of Providers:
Coordination of Services
Children’s
Health
Council
Community
Solutions
Feedback Loop
Provider
Gardner
Family Care
Alum Rock
Counseling
Center
Mental Health
Services
Developmental
Services
MHD
KidScope
Kidango
Feedback
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EMQ Families
First
Connection to Early
Start & School
District Services
Catholic
Charities 14
Regional Assessment Centers
Self-Referral
Rebekah’s
Children’s
Services
What we’ve learned so far…
Selected Outcomes FY 12-13
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Ensuring Children Thrive
It is projected that at the end of FY 12-13, 2250 children aged 0-5 will have
received services under Santa Clara County’s KCN Network of Providers.
This is an increase of 29% from the previous year.
Desired Outcomes:
1) children are born and remain healthy.
2) Families have the skills, support & resources they need to promote their
children’s optimal development, and
3) children have age-appropriate competencies (social, emotional and cognitive)
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ASQ-3 and ASQ:SE Presenting Concerns
Percentage of Children Served in KCN FY 12-13 Presenting with Initial
Concerns as Measured by the ASQ-3 and ASQ:SE
63%
N = 521 ASQ-3 and 496 ASQ:SE
Screenings
30%
23%
19%
15%
10%
Communication
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Gross motor
Fine motor
Problem Solving
Personal Social
ASQ:SE
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Our children have high levels of need
• Presenting concerns: CBCL Symptom Cluster
– Note, symptom clusters do not directly correlate to diagnosis
% in Clinical Range at Initial
Assessment-System Clusters
Attention
30%
Anxiety
32%
Anger/Aggression
Affective (Mood)
36%
38%
Top Presenting Concerns of Children
Referred to KCN: FY 12-13-Q1-2
% in Clinical Range at Initial
Assessment
Social /
Communication/
Symbolic Thinking
54%
38%
Affective (Mood)
36%
Anger/Aggression
Social / Communication/
Symbolic Thinking
54%
N = 388 completed initial
assessments using the Child
Behavior Checklist
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Anxiety
Attention
32%
30%
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Parent-Child Relationships Improved
Improvements in Parent-Child Relationships as Measured by the KIPS: KCN Home
Visiting and Therapeutic Services:
Q1-2 FY 12-13
INITIAL
3.73
1. SENSITIVITY OF
RESPONSES
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*all are statistically significant
4.31
4.25
4.12
3.42
FOLLOWUP
3.81
3.75
3.18
2. SUPPORTS EMOTIONS 3. PHYSICAL INTERACTION
4.10
3.16
4. INVOLVEMENT IN
CHILD'S ACTIVITIES
5. OPEN TO CHILD'S
AGENDA
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Promoting Learning
Improvements in Parent's Skill in Promoting Learning as Measured by the KIPS:KCN
Home Visiting and Therapeutic Services:
Q1-2 FY 12-13
INITIAL
FOLLOWUP
3.94
3.86
3.67
3.35
6. LANGUAGE EXPERIENCES*
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3.29
*statistically significant
3.06
3.19
3.15
7. REASONABLE EXPECTATIONS* 8. ADAPTS STRATEGIES TO CHILD* 9. LIMITS AND CONSEQUENCES
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Supporting Child’s Confidence: Improved
Improvements in Parent's Skill in Supporting Child's Confidence as Measured by the
KIPS: KCN Home Visiting and Therapeutic Services:
Q 1-2 FY 12-13
INITIAL
*All are statistically
significant
4.00
3.35
10. SUPPORTIVE DIRECTIONS
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FOLLOWUP
3.96
3.42
11. ENCOURAGEMENT
3.89
3.83
3.28
3.25
12. PROMOTES
EXPLORATION/CURIOSITY
13. KIPS MEAN SCORE
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Where We Are Going…
Systems Working Together to Support
Developmental Screening
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Universal Developmental Screening:
Santa Clara County Leading the Way
Source: http://www.sccgov.org/sites/opa/nr/Documents/State%20of%20the%20County%20Address%202013.pdf
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FIRST 5 Santa Clara County
Partnership with the Superior Court and
Child Welfare Systems
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Partnerships
FIRST 5 has strong, collaborative relationships with county agencies
and departments and community partners, allowing for the expansion
and strengthening of our countywide System of Care, maximization of
revenue and assurance that programs are sustainable over time.
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Making Connections –
Family Support Specialists & Public Health Nurses
Family Support Specialists & Public Health Nurses
Superior Court and Child Welfare Systems
Family Court
Juvenile Justice
Family Support Specialists
Dependency
Public Health Nurses
Assessment
Therapeutic Services
Home Visitation
Early Care &
Education
Family Resource
Centers
Early Start/ School
District
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Santa Clara County Superior Court:
Family Court
Family Court
• Family Support Specialists provide:
• Developmental Screenings, Needs
Assessments and connect families to
FIRST 5 and community programs.
• Staff is stationed in each of the county Family
Court Houses to connect directly on-site with
families and to receive referrals.
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Santa Clara County Superior Court:
Juvenile Justice Court
Juvenile Justice Court
• Family Support Specialists provide:
• Developmental Screenings, Needs
Assessments and connect pregnant and
parenting teens to FIRST 5 system of care.
• Referrals are made directly from Judges and
Probation Officers.
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Santa Clara County Superior Court:
Juvenile Dependency
• Family Support Specialist sits as a member of
the Dependency Wellness Court team to
provide information and resources regarding
community resources and child development.
• Public Health Nurses provide Nursing
Assessments, Depression Screening, ASQ
and ASQ:SE screenings to all children
involved in the child welfare system
• Families are connected to other FIRST 5 and
community programs.
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NCFAS Assessment of Family Court Participants
Overall environment is not shown, as there was no
measureable change in % after 90 days
All improvements are statistically significant at
p < 0.00001
100%
89%
84%
82%
82%
80%
67%
60%
48%
43%
44%
42%
40%
36%
20%
0%
Overall child well-being Overall family interactions
Overall family safety
Initial % with strengths
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Overall parental
capabilities
Average % Across All
Domains
Followup % with strengths
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Public Health Nursing – Home Visitation
Highlights
Children in dependency court were more likely to receive the recommended number of
well-child visits and less likely to visit the ER room at follow-up
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Public Health Nursing – Home Visitation Highlights
Children in
dependency court
were more likely to
receive adequate
dental care at followup
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Public Health Nursing - ASQ and ASQ-SE Highlights
Children in dependency court matched at baseline and follow-up presented
with significantly fewer concerns in all domains at follow-up
Decreased %
indicates
improvement
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FIRST 5 Santa Clara County: State and Local
Recognition
Superior Court of California County of Santa Clara
Support for Family and Juvenile Courts Award
2012
Legal Advocates for Children and Youth
Innovative Program Award
2011
Judicial Council of California
Ralph N. Kleps Award for Improvement
in the Administration of the Courts
2009
Association of Family and Conciliation Courts
Irwin Cantor Award for Innovative Programs
2008
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Questions and Answers
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For More Information
Melanie Daraio
Rachel Talamantez
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FIRST 5 Santa Clara County
4000 Moorpark Ave., Suite 200
San Jose, CA 95117
Phone: (408) 260-3700
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